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Some families may need support with early introduction of peanut

Published: November 28, 2023

Current guidelines recommend that high risk infants introduce peanut starting between 4-6 months of age, but families may face barriers in maintaining peanut in their children’s diet.

In a recent study published in the The Journal of Allergy and Clinical Immunology: In Practice, Keet et al. describe peanut introduction in a cohort of infants aged 4-11 months old. Infants who were potentially at high risk for peanut allergy because of a history of moderate to severe eczema, other food allergy and/or family history of peanut allergy but who had not previously introduced peanut or had peanut allergy testing were enrolled. Participants were skin tested to peanut and, based on skin testing, had observed peanut introduction, peanut oral food challenge, or were deemed peanut allergic. Those who were not peanut allergic were advised to introduce peanut according to current guidelines. Follow-up included short monthly questionnaires about peanut consumption, office visits at 18 and 30 months of age, and unscheduled office visits for suspected peanut allergy or sustained discontinuation.

Two hundred and seventy seven participants without peanut allergy at baseline were followed. Only 6 participants developed peanut allergy, of whom 2 were diagnosed with the non-IgE mediated peanut allergy food protein induced enterocolitis syndrome (FPIES), 2 occurred shortly after introduction, and 2 were in participants who did not introduce peanut regularly. Even though nearly one quarter of participants discontinued peanut for at least one month, nearly 90% were still consuming peanut at the last known observation. While most families found introduction easy, about one quarter of families said that peanut introduction was difficult. Among those who discontinued, the most common cited reason was fear of a peanut-allergic sibling reacting. Despite the fear of sibling reactions, such reactions were rare (<2%). In contrast, reactions in peanut allergic parents related to the infant’s feeding were much more common, approaching 20% of peanut allergic parents.

Overall, this study is reassuring that following early introduction, peanut allergy is rare and most families find introduction to be easy. However, the data suggest that there is a subset of families, particularly those with a peanut allergic family member, who may need support with this introduction.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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